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[PMID]: | 27771291 |
[Au] Autor: | Rosenberg AS; Ruthazer R; Paulus JK; Kent DM; Evens AM; Klein AK |
[Ad] Endereço: | Division of Hematology/Oncology, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA; Division of Hematology/Oncology, Department of Internal Medicine, Tufts Cancer Center, Boston, MA; Department of Internal Medicine, Tufts Medical Center, Boston, MA. Electronic address: |
[Ti] Título: | Survival Analyses and Prognosis of Plasma-Cell Myeloma and Plasmacytoma-Like Posttransplantation Lymphoproliferative Disorders. |
[So] Source: | Clin Lymphoma Myeloma Leuk;16(12):684-692.e3, 2016 Dec. | [Is] ISSN: | 2152-2669 |
[Cp] País de publicação: | United States |
[La] Idioma: | eng |
[Ab] Resumo: | BACKGROUND: Multiple myeloma/plasmacytoma-like posttransplantation lymphoproliferative disorder (PTLD-MM) is a rare complication of solid organ transplantation. Case series have shown variable outcomes, and survival data in the modern era are lacking. PATIENTS AND METHODS: A cohort of 212 PTLD-MM patients was identified in the Scientific Registry of Transplant Recipients between 1999 and 2011. Overall survival (OS) was estimated by the Kaplan-Meier method, and the effects of treatment and patient characteristics on OS were evaluated by Cox proportional hazards models. OS in 185 PTLD-MM patients was compared to 4048 matched controls with multiple myeloma (SEER-MM) derived from Surveillance, Epidemiology, and End Results (SEER) data. RESULTS: Men comprised 71% of patients; extramedullary disease was noted in 58%. Novel therapeutic agents were used in 19% of patients (more commonly during 2007-2011 vs. 1999-2006; P = .01), reduced immunosuppression in 55%, and chemotherapy in 32%. Median OS was 2.4 years and improved in the later time period (adjusted hazard ratio [aHR], 0.64, P = .05). Advanced age, creatinine > 2 g/dL, white race, and use of OKT3 were associated with inferior OS in multivariable analysis. OS of PTLD-MM patients is significantly inferior to SEER-MM patients (aHR, 1.6, P < .001). Improvements in OS over time differed between PTLD-MM and SEER-MM. Median OS of patients diagnosed from 2000 to 2005 was shorter for PTLD-MM than SEER-MM patients (18 vs. 47 months, P < .001). There was no difference among those diagnosed from 2006 to 2010 (44 months vs. median not reached, P = .5; interaction P = .08). CONCLUSION: Age at diagnosis, elevated creatinine, white race, and OKT3 were associated with inferior survival in patients with PTLD-MM. Survival of PTLD-MM is inferior to SEER-MM, although significant improvements in survival have been documented. |
[Mh] Termos MeSH primário: |
Transtornos Linfoproliferativos/etiologia Transtornos Linfoproliferativos/mortalidade Mieloma Múltiplo/etiologia Mieloma Múltiplo/mortalidade Transplante de Órgãos/efeitos adversos Plasmocitoma/etiologia Plasmocitoma/mortalidade
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[Mh] Termos MeSH secundário: |
Idoso Feminino Seres Humanos Imunossupressão/efeitos adversos Estimativa de Kaplan-Meier Transtornos Linfoproliferativos/diagnóstico Transtornos Linfoproliferativos/terapia Masculino Meia-Idade Mieloma Múltiplo/diagnóstico Mieloma Múltiplo/terapia Plasmocitoma/diagnóstico Plasmocitoma/terapia Prognóstico Modelos de Riscos Proporcionais Fatores de Risco Programa de SEER Análise de Sobrevida Estados Unidos/epidemiologia
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[Pt] Tipo de publicação: | JOURNAL ARTICLE |
[Em] Mês de entrada: | 1711 |
[Cu] Atualização por classe: | 171201 |
[Lr] Data última revisão:
| 171201 |
[Sb] Subgrupo de revista: | IM |
[Da] Data de entrada para processamento: | 161025 |
[St] Status: | MEDLINE |
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